Treatment of Infantile Spasms

The American Academy of Neurology and the Child Neurology Society have released new guidelines on treating infantile spasms. “Practice Parameter: Medical Treatment of Infantile Spasms” appears in the May 2004 issue of Neurology and is available online at
http://www.neurology.org/cgi/reprint/62/10/1668.

Infantile spasms, also called West Syndrome, is a rare disorder that usually begins in infants four to six months of age and stops by the age of two to four years. The spams are a type of seizure associated with sudden flexion or extension movements. Infantile spasms rarely respond to the usual antiseizure medications. Most children with infantile spasms have developmental disabilities later in life.

The authors of the guideline reviewed all of the scientific studies on the topic. According to the authors, there are not many well-designed, prospective studies on infantile spasms, and more research is needed to answer many questions about the treatment of this disorder.

According to the guideline, adrenocorticotropic hormone is probably effective for the short-term treatment of infantile spasms. However, there is not enough evidence to recommend the optimum dosage and length of treatment. There also is insufficient evidence to determine whether oral corticosteroids are an effective treatment for infantile spasms.

The drug vigabatrin is possibly effective for the short-term treatment of infantile spasms and is possibly effective for children with tuberous sclerosis. The evidence suggests that the vision of children taking vigabatrin should be tested regularly, because the drug can affect the retina.

There is insufficient evidence to recommend other treatments for infantile spasms, and there is insufficient evidence to conclude that successful treatment of infantile spasms improves the long-term prognosis, according to the authors.